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The patient in the given case study is an 80-year-old female who is admitted in the clinical setting for post-operative management after getting right total posterior hip replacement. The patient is residing in her home along with her husband who is 83-years-old. She takes care of herself on her own as well as of her husband. The patient resides in an area which is 65 km away from the city. She is having her daughter who lives nearby and helps her with her daily chores and managing her health. The patient is suffering from multiple ailments, for which she is on medication management. The patient is a known case of osteoarthritis and hypocholesterolaemia since 2001. She is having a surgical history of left total knee replacement in 2017 and right total knee replacement in 2009. Apart from other conditions, patient is also suffering from hypertension, type-2 diabetes and hypothyroidism since 1980. She is having no personal history of smoking; however, she drinks occasionally. The patient is currently suffering from chronic pain in her right hip for which she had been advised to get surgical intervention. The patient case will be pondered upon from the point of view of post-operative management and the nursing care and coordination which will be required to help the patient in recovering from the same. The case will also help in highlighting the concept of defining short-term and long-term goals for the patient, to formulate the basis of treatment. The case will also guide about the discharge planning for this patient, with the help of multidisciplinary approach.
The transition of degenerative changes has been significantly found to be directly associated with aging process in population (Briggs, 2019). This has been caused to find an increased prevalence of problems in elderlies. Musculoskeletal disorders such as degenerative joints as well as arthritic conditions have been defined as the most common cause of chronic pain in elderlies. Some of the other significant conditions include, pain of neuropathic origin, pain of ischemic origin or pain developed from various other chronic and progressive ailments. These degenerative changes have also been found to bring about a huge ordeal of discomfort and pain in the patients (Blyth, 2017). This chronic pain has been found to add to the health burden in elderlies as well, adding to the restriction of the activities of daily living. There has also been a direct linkage observed in elderlies suffering from chronic pain to have cognitive disturbances and adding to the underlying risk factors in these population groups. There are multiple factors that might lead to an increase in pain and pain sensitivity in the elderlies. The primary onset can be defined as the physiological changes in the elderlies. These changes are brought about by a decreased release in neurotransmitters such as GABA, serotonin, noradrenaline and so on (Liao, 2018). Due to a deficiency in production of the same, there is a decrease competence of peripheral nociceptive neurons observed. This mechanism brings about an increased pain threshold and reduces the overall endogenous analgesic response. These actions cumulatively result in paradoxical increase in pain, leading to hampered activity. Another pathophysiological factor can be ascertained as homeostenosis process related with aging (Bolduc, 2019). This process leads to a loss of homeostatic reserve in various body organs systems functioning. Thus, leading to increase decline in liver and renal functioning, decreased muscle frailty causing falls, decreased appetite, depression, delirium and an overall behavioural display of irritability. This chronic pain can bring about an overall increased reported incidence of adverse outcomes. These adverse outcomes can be observed in the form of functional impairments, fall, depression and disturbance in overall living pattern of the patient. Chronic pain management in elderlies can be a challenging task, making it more difficult to manage and evaluate their condition. There is also an added impairment observed in elderlies, which can lead to misleading reporting of the pain experienced by them.
Through the use of extensive assessment tools, the chronic pain in elderlies can be evaluated and managed efficiently. For enabling care for the patient in the given case scenario a holistic assessment should be carried out for the patient. There are multiple factors that should be assessed as follow:
Treatment and management of this patient mainly depends on the short-term and long-term goals defined. The short-term goals can be defined as follow:
The long-term goals can be defined in the case as mentioned-below:
Managing a post-operative case can be quite challenging and involves the role of multidisciplinary approach for handling patient care. The challenge multiplies by several folds when the patient is of aged population. However, with a comprehensive and detailed assessment, a well-crafted intervention care plan can be devised, by the means of patient-centred approach model of care. This will be helpful in getting positive healthcare outcomes post-implementation of these strategic interventions’ management for patient care.
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